For the novice clinician, the task of learning how to conduct psychotherapy is both personally and professionally challenging. Trainees, who may be quite competent at teasing out psychological complexity in the classroom or in case conference, may find themselves adrift in the therapy room. Seemingly straightforward clinical interventions are found to be less so in actual practice, and interpersonal skills, which may have served trainees well in their personal lives, may be strained in their attempts to develop an effective therapeutic relationship. By its very nature, psychotherapy is a complex interpersonal process that requires the clinician to incorporate theory and evidence-based practices in a systematic, yet flexible, manner to enhance client collaboration and to promote understanding and cognitive and behavior change. The training process is further complicated by the multiple, and often competing, approaches that may be taken in treatment.Psychotherapy-based supervision orders the learning process by providing a coherent approach to therapy in which knowledge, theory, and technique derived from a specific orientation inform the conduct of treatment and provide a clear focus for supervision. Further, techniques used in therapy may be tailored and used as learning strategies in supervision, for instance, attending to dreams in psychodynamic supervision or assigning homework in cognitive therapy 57
This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to Brief Feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18 weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18 weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.
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